Coordinator - Third Party Audits

Overview Research Patient accounts related with audits and activity from Third Party Payers and internal audits in accordance with therequired timeframe. Identify and report root cause for all audit recoveries by Third Party Payers and recommends andparticipate in corrective action plan for Bronxcare Health System/MLK. Responsibilities Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service Identifies and reports root causes for Audit recoveries by Third Party Payers and recommend /participate in corrective action for BCHS and MLK. Communicate with all Third Party Payers and internal parties to obtain required information to finish the assignment satisfactorily and within the required time frame.Responsible to ensure compliance regarding billing and timeliness on followup for all assigned accounts received. Utilizes all information systems toretrieve, verify and or appeal denied cases in payer web portal as appropriate Responsible for obtaining medical records for claims that are denied by the payer requesting clinical information. Obtains and submits medical records to the payer, as required. Reviews and obtains UM status and or action recorded Qualifications Three (3) to Five (5) years’ experience of collection in finance knowledge of Medicare and Medicaidreimbursement processing preferredExperience with the maintenance of the patient file informationExperience in billing information systemsExperience in a Health Care environment preferredStrong communication skills both verbal and writtenGood analytics skillsAbility to multi-task and willingness to learn new skillsAbility to deal effectively with multiple information sources Job LocationsUS-NY-Bronx ID2023-4287 Category Administrative/Clerical Position Type Regular Full-Time Division Bronxcare Hospital Center - Concourse Max USD $52,500.00/Yr. Shift Day Shift Department : Name Patient Financial Services (BHCS)